Provider Demographics
NPI:1306917992
Name:NEUROLOGY ASSOCIATES OF NORWALK, P.C.
Entity type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF NORWALK, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-853-5000
Mailing Address - Street 1:605 WEST AVENUE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4004
Mailing Address - Country:US
Mailing Address - Phone:203-853-5000
Mailing Address - Fax:203-853-5001
Practice Address - Street 1:637 WEST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-4004
Practice Address - Country:US
Practice Address - Phone:203-853-5000
Practice Address - Fax:203-853-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004001616Medicaid
CTC00609Medicare ID - Type Unspecified